Post-Surgery Concerns After Hemorrhoid and Fistula Procedures

Postoperative issues related to hemorrhoid surgery?

Hello, Doctor: About four months ago, I underwent minimally invasive surgery for a fistula and internal hemorrhoids.
During my follow-up visits, the attending physician mentioned that my recovery was going well and advised me to apply ointment and take warm sitz baths daily, which I have been doing (once in the morning and once in the evening).
However, I still have a few concerns, so I would like to ask the following questions.
Thank you, Doctor.
1.
Currently, my bowel movements are normal, and I do not experience constipation or difficulty in passing stools.
However, I often feel a sense of urgency and swelling in the anal area, and I experience slight discomfort in the internal anal region in certain positions.
I would like to know the possible reasons for this.
2.
The hemorrhoid ointment prescribed by my doctor comes with a plastic applicator.
Should I insert the plastic applicator into the anus or use my finger to apply the ointment to the rectum? Since my doctor has not examined the inside post-surgery and only checked the external anal wound, I would like to know if invasive treatments or examinations are not recommended shortly after surgery.
3.
Following up on question 2, if I later require a colonoscopy, how long after the surgery should I wait to undergo such examinations?
4.
Since I have observed that there are no longer any wounds on the external anal area, should I continue applying the hemorrhoid ointment? Will applying it externally be effective for internal hemorrhoids as well?
Thank you for clarifying these concerns, Doctor.

Leo, 20~29 year old female. Ask Date: 2024/02/19

Dr. Zhang Shuhao reply Surgery

1.
The sensation of urgency and swelling in the anal area, along with occasional discomfort inside the anus, may be due to scar tissue.
If there are no other symptoms, it can be monitored further.

2.
When applying hemorrhoid ointment, it is usually not necessary to insert the plastic tube into the anus.
You can squeeze a small amount of ointment onto your fingertip and gently apply it to the skin around the anus, with an inward depth of about half a fingertip.
Typically, wounds heal within four months, and a digital examination or colonoscopy can be performed if needed.
3.
If it is not urgent, a colonoscopy will be scheduled six to eight weeks post-surgery; however, urgent situations are exempt from this timeline.
4.
By four months, wounds both internally and externally are usually healed, and there may be no need to continue using ointment.
If discomfort occurs after bowel movements, warm sitz baths can be continued.
While applying ointment can alleviate symptoms, long-term use is not recommended.
If necessary, follow-up visits can be scheduled to consult your doctor for further advice.

Reply Date: 2024/02/19

More Info

Post-surgery concerns following hemorrhoid and fistula procedures are quite common, and it’s important to address them to ensure a smooth recovery. Based on your questions, let’s delve into each concern.

1. Persistent Rectal Sensation and Swelling: It’s not unusual to experience a sensation of urgency or swelling in the anal area after surgery. This could be due to several factors, including inflammation from the surgical site, residual swelling, or even nerve sensitivity following the procedure. The body often takes time to heal, and the tissues in the anal region can remain sensitive for weeks or even months post-surgery. If the discomfort persists or worsens, it would be advisable to consult your physician for further evaluation, as they may want to rule out any complications such as infection or the formation of scar tissue.

2. Application of Medicated Ointment: Regarding the use of the medicated ointment with a plastic applicator, it is generally recommended to follow the instructions provided by your physician or the product label. In many cases, it is acceptable to gently insert the applicator into the rectum to apply the medication, but this should be done with caution to avoid causing any additional discomfort or injury. If you are experiencing significant pain or discomfort, it may be best to apply the ointment externally and consult your doctor for personalized advice. After surgery, invasive procedures or examinations are typically avoided for a certain period to allow for proper healing, so it’s wise to discuss any concerns about invasive applications with your healthcare provider.

3. Timing for Colonoscopy or Similar Procedures: After undergoing surgery for hemorrhoids and fistulas, it is crucial to allow adequate time for healing before undergoing invasive procedures like a colonoscopy. Generally, most surgeons recommend waiting at least 4 to 6 weeks post-surgery, but this can vary based on individual recovery and the extent of the surgery. It’s best to have a discussion with your surgeon regarding the appropriate timeline for any follow-up procedures.

4. Continuation of Ointment Use: If your external wounds have healed and you no longer experience pain or discomfort, you may not need to continue using the hemorrhoid ointment. However, if you still feel any residual discomfort or if your doctor advised you to continue using it for a specific duration, it may be beneficial to do so. Applying the ointment externally can still provide some relief for internal hemorrhoids, as it may help soothe the surrounding tissues. Always consult your physician before making changes to your medication regimen.

In summary, while some discomfort and sensations are normal after hemorrhoid and fistula surgeries, persistent or worsening symptoms should be evaluated by a healthcare professional. Proper application of medications, timing for further examinations, and ongoing care are essential components of your recovery process. Always prioritize open communication with your healthcare provider to ensure that your recovery is on track and to address any concerns you may have.

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